Radomski J S, Chojnacki K A, Moritz M J, Rubin R, Armenti V T, Wilson G A, Herrine S, Conn M
Department of Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Am Surg. 2000 Nov;66(11):1067-70.
Liver transplantation has been performed in individuals with a pretransplant clinical diagnosis of cirrhosis but with nodular regenerative hyperplasia histologically. The purpose of this report is to investigate the results of liver transplantation in patients proven to have nodular regenerative hyperplasia post-transplant. A retrospective review was undertaken of four patients who underwent liver transplantation with a histologic diagnosis of nodular regenerative hyperplasia. All were felt to be cirrhotic on clinical grounds. Final histology of the explanted liver was confirmed by a single pathologist. Their ages ranged from 39 to 54 years, and three of the four were male. Three had pretransplant needle liver biopsies, two percutaneous and one transjugular. All revealed nonspecific reactive changes. Ultrasound and MRI were interpreted as consistent with cirrhosis in four of four and three of four cases, respectively. Portal vein flow was hepatopedal in three and absent in one. Pretransplant clinical characteristics and frequency were as follows: bleeding varices two, clinical ascites three, encephalopathy three, and impaired hepatic synthetic function two. All four patients underwent successful liver transplantation. There were no episodes of acute rejection. All are alive and well with normal graft function 2 to 4 years post-transplant. We conclude the following. 1) Patients with clinical end-stage liver disease due to underlying nodular regenerative hyperplasia can successfully undergo transplantation. 2) Nodular regenerative hyperplasia can present with signs and symptoms of liver failure, is difficult to diagnose by needle biopsy, and can be difficult to discriminate clinically from cirrhosis. 3) Although each case must be individually evaluated transplantation may be the optimal therapy in patients presenting with complications of liver failure.
肝移植已在移植前临床诊断为肝硬化但组织学表现为结节性再生性增生的个体中进行。本报告的目的是研究经证实移植后患有结节性再生性增生的患者肝移植的结果。对4例组织学诊断为结节性再生性增生的肝移植患者进行了回顾性研究。所有患者临床均被认为患有肝硬化。切除肝脏的最终组织学诊断由一名病理学家确认。他们的年龄在39岁至54岁之间，4例中有3例为男性。3例患者移植前进行了肝脏穿刺活检，2例为经皮穿刺，1例为经颈静脉穿刺。所有活检均显示非特异性反应性改变。超声和MRI检查结果分别在4例中的4例和4例中的3例中被解释为与肝硬化一致。3例门静脉血流为向肝血流，1例无门静脉血流。移植前的临床特征及出现频率如下：静脉曲张出血2例，临床腹水3例，肝性脑病3例，肝脏合成功能受损2例。所有4例患者均成功进行了肝移植。无急性排斥反应发生。所有患者在移植后2至4年均存活且移植肝功能正常。我们得出以下结论。1）因潜在的结节性再生性增生导致临床终末期肝病的患者能够成功接受移植。2）结节性再生性增生可表现为肝衰竭的体征和症状，通过穿刺活检难以诊断，且在临床上难以与肝硬化相鉴别。3）尽管每个病例都必须单独评估，但对于出现肝衰竭并发症的患者，移植可能是最佳治疗方法。
